Patient care more important than bureaucratic red tape

Published 8:00 am Thursday, March 31, 2016

The Michigan Preferred Drug List (PDL) is a list of medications that physicians can prescribe to their patients on Medicaid without getting prior authorization from the state. The goal of the PDL is to help control costs and direct health care providers to the most cost-effective treatments.

Prior authorization usually includes a process implemented by the state to delay or deny particular prescription drugs to those on Medicaid. The process often requires a doctor to obtain pre-approval from the state before prescribing a given drug or verify to the state that use of the drug meets the state’s predetermined criteria.

While well-intended, requiring prior authorization has had its problems.

For starters, it directly interferes with the ability of a doctor to do his or her best to help a patient. If a drug that a doctor believes is necessary is subject to prior authorization, it may restrict access to that medication to patients in need.

This is especially important for mental health — where access to drugs can prevent crime and lead to a greater societal benefit — and for patients who cannot take drugs on the preferred list due to other medical issues they are facing.

Generics are not always okay, and chemical interactions sometimes pop up when very specific drugs are not administered when treating mental health disorders. This can be disruptive and potentially lead to additional crime and costs to society if the preferred drug list keeps the right medications from potential offenders.

That is why I am working on language for the Fiscal Year 2017 Department of Health and Human Services budget to help ensure everyone has timely access to the prescription drugs they need.

My changes would exempt certain Medicaid drugs from prior authorization. Drugs that are generally recognized in a standard medical reference for the treatment of cancer, a psychiatric disorder, HIV-AIDS, epilepsy or organ replacement therapy would be exempt.

Containing health care costs is important, but government should not be penny-wise and pound-foolish when it comes to patient care.

We should be protecting and promoting the doctor-patient relationship. It’s focused on the best possible care for the patient, and that is good for everyone.


Sen. John Proos, R-St. Joseph, represents Southwest Michigan.